Ever since his coruscating book Mad in America was published in 2002,
American Robert Whitaker has been a poster boy for the anti-psychiatry
movement. In Mad in America (Perseus Books), he argued that the
assumption of a physical cause for schizophrenia had given rise to many
wrongheaded treatments, from ice-water immersion to today's
antipsychotic drugs. These days, the Pulitzer Prize finalist makes a
similar case against psychiatry over its approach to the treatment of
depression.

No one knows for sure whether serotonin has a role in depression, let
alone exactly what that role might be. But many doctors pretend they're
sure, Whitaker says, because "psychiatry for a long time had a bit of
an inferiority complex. It wanted magic bullets like everybody else."
Trouble is, the magic bullets, including the SSRIs, don't work very
well. By perturbing neurotransmitter activity they can make patients
chronically ill, says the Boston-based author.

Is he alleging a conspiracy among psychiatrists? Not exactly.
Psychiatrists are taught the biological models of mental illness and
come to believe in them, he says. He recalls a recurring exchange he
had with doctors while researching Mad in America:

Psychiatrist: The (schizophrenia) drugs are like insulin for diabetes.
Whitaker: No, they're not - you have no confirmed biological problem.
Psychiatrist: O.K., that's true.
Whitaker: So why say it?
Psychiatrist: Well, it gets people to take their drugs.

"So what they're doing is a little fudging to pursue what they
believe is a good end," says Whitaker. "But at the same time they feel
vulnerable because they don't have the science behind it and they don't
have the outcomes, either." Those psychiatrists who break ranks and
publicly question the biological models and the efficacy of psychiatric
drugs, he adds, "get clobbered. They basically have their careers
ruined."

The SSRIs, in his view, are a story of a "massively
successful capitalistic enterprise" - and the idea that in countries
like Australia there's still a multitude of people with undiagnosed
depression should be considered in that context. These people are "not
clinically depressed, anyway," he says. "The drug companies are setting
forth an unrealistic vision of what it is to be human. They're defining
normal stresses and worries as pathological, and the only reason
they're doing it is that it leads to more business."